T
heoreTical
S
Tudy
RESUMO
A Classiicação Internacional para a Práica de Enfermagem (CIPE®) é um sistema de classificação unificador dos elementos da práica de enfermagem (diagnósicos, resultados e intervenções), que possibilita elucidar elementos da linguagem própria da Enfermagem por meio da construção de subconjuntos terminológicos. Neste ensaio relexivo, destacam-se aspectos relevantes para a construção de subconjuntos termi-nológicos CIPE®, bem como suas contribui-ções para a práica clínica do enfermeiro. Discute-se a elaboração de subconjuntos como ferramenta que contribui para a universalização da linguagem da Enferma-gem, facilita o processo comunicaivo, bem como o avanço cieníico e tecnológico da proissão. Portanto, inceniva-se seu uso por enfermeiros de todo o mundo.
DESCRITORES
Enfermagem Terminologia Vocabulário Classiicação
ABSTRACT
The Internaional Classiicaion for Nursing Pracice (ICNP®) is a classiicaion system that uniies the elements of nursing prac-ice (diagnoses, intervenions and outco-mes), enabling elucidation of elements of a specific nursing language through the construcion of terminology subsets. In this relecive essay, aspects relevant to the construcion of ICNP® terminology subsets are highlighted, as well as their contribuions to clinical nursing pracice. The development of subsets as a tool that contributes to making nursing language universal, facilitates the communicaion process, as well as the scieniic and tech-nological advancement of the profession, is discussed. Therefore, its use by nurses worldwide is encouraged.
DESCRIPTORS
Nursing Terminology Vocabulary Classiicaion
RESUMEN
La Clasiicación Internacional para la Práci-ca de Enfermería (CIPE®) es un sistema de clasificación unificador de los elementos de la prácica de enfermería (diagnósicos, resultados e intervenciones), lo que permite dilucidar los elementos del lenguaje propios de Enfermería a través de la construcción de subconjuntos de terminología. En este ensayo relexivo, se destacan los aspectos relevantes para la construcción de un subconjunto de terminología CIPE®, así como sus contribu-ciones para la prácica clínica del enfermero. Se discute el desarrollo de subconjuntos como una herramienta que contribuye para el lenguaje universal de la Enfermería, lo que facilita el proceso de comunicación, así como el avance cieníico y tecnológico de la profe-sión. Por lo tanto, su uso es incenivado por las enfermeros de todo el mundo.
DESCRIPTORES
Enfermería Terminología Vocabulario Clasiicación
Construction of terminology subsets:
contributions to clinical nursing practice
ConstRução de subConjuntos teRmInológICos: ContRIbuIções à PRátICA ClínICA do enfeRmeIRo
ConstRuCCIón de subConjuntos de teRmInologíA: ContRIbuCIones PARA lA PRáCtICA ClínICA del enfeRmeRo
Jorge Wilker Bezerra Clares1, Maria Célia de Freitas2,
Maria Vilaní Cavalcante Guedes3, Maria Miriam Lima da Nóbrega4
1 master’s student, Postgraduate Program in Clinical Care in nursing and Health, state university of Ceará. member of the Research group nursing, education,
Health and society. fortaleza, Ce, brazil. e-mail: jorgewilker_clares@yahoo.com.br 2 doctorate in nursing. Professor, Postgraduate Program in Clinical
Care in nursing and Health, state university of Ceará. member of the Research group nursing, education, Health and society. fortaleza, Ce, brazil. e-mail: celfrei@hotmail.com 3 doctorate in nursing. Professor, Postgraduate Program in Clinical Care in nursing and Health, state university of Ceará. leader of
the Research group nursing, education, Health and society. fortaleza, Ce, brazil. fortaleza, Ce, brazil. e-mail: vilani_guedes@hotmail.com 4 doctorate in
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contributions to clinical nursing practice Clares JWB, Freitas MC, Guedes MVC, Nóbrega MML
INTRODUCTION
Nursing has been concerned about its consolidaion as a science and strengthening of its pracice in diferent contexts of care. That demands a speciic language which deines and describes its performance and professional acions. However, the lack of this vocabulary hinders the assimilaion of terms needed to classify and name its prac-ice, which leads to eforts of nurses worldwide in search of scieniic development of the profession(1).
The efort for a speciic nursing vocabulary or language led to the development of classiicaion systems that have aroused the interest of nurses in the use of a speciic profes-sional language, through the adopion of terms atributed to the phenomena of their clinical pracice, thereby resuling in uniicaion and standardizaion of communicaion and informaion exchange among nurses, in order to strengthen the autonomy and recogniion of social pracice.
Nursing currently counts on several classiicaion sys-tems related to some of the elements of the nursing pro-cess, such as diagnoses, intervenions and
outcomes. The Internaional Classiicaion for Nursing Pracice (ICNP®) is an important technological resource that brings together nursing diagnostic terms and concepts, outcomes and intervenions in the same classiicaion. This classiicaion represents an important informaion tool to describe the elements of clinical nursing pracice, to provide data that ideniies its contribu-ion to health care, to promote changes in clinical nursing pracice through educaion, administraion and research. Its use results in greater visibility and professional recog-niion, promoing more autonomy to the profession(2-4). Therefore, it is an important
resource for clinical nursing care, subsidizing nurses’ acions in diferent contexts of professional pracice.
Clinical care is understood as the set of practices, intervenions and systemaized acions, direcing care, developed by the nursing staf and directed to the human being, both to an individual or a community, based on quanitaive and/or qualitaive evidence, with philosophical, ethical, aestheic, technical and poliical bases, considering the manifestaions or responses of people to their living process in the health-disease coninuum. It does so by using scieniic and theoreical knowledge through technologies in order to maintain or improve the health condiion of the person cared for, promoing comfort, well-being and quality of life(5).
The Internaional Classiicaion for Nursing Pracice is in a technology that allows the organizaion of clinical care and the scieniic, technological and innovaive professional advancement by enabling the development of terminology subsets targeted to speciic areas of clinical pracice. These
subsets consist of airmaive clusters of nursing diagnoses, outcomes and intervenions that favor the adopion of a uniied accessible language to nurses in all countries, as re-commended by the Internaional Council of Nurses (ICN)(6). In order to enhance the use of ICNP®, the ICN has encouraged the paricipaion of nurses worldwide in the development of terminology subsets as an alternaive to unify nursing language, as well as to idenify, explain and evaluate the elements that describe their pracice.
This study aimed to make a theoreical relecion about aspects relevant to the construcion of ICNP® terminology subsets, and to discuss its contribuions to clinical nursing pracice.
CONSTRUCTION OF ICNP®
TERMINOLOGY SUBSETS
In 2010, a process model to construct ICNP® subsets was published with six stages distributed in the three main components of the life cycle of this termi-nology, namely: Research& Development (ideniicaion of clients and health priori-ies and collecion of terms and concepts relevant to the priority); Maintenance &
Operaions (mapping of concepts ideniied
into the ICNP® terminology and modeling of new concepts) and Disseminaion & Educa
-ion (inalizaion and disseminaion of the catalogue)(6). The process of construcion of ICNP® terminology subsets is described in the following paragraphs.
Research & Development
This component involves ideniicaion of clients and health prioriies. The client corresponds to individuals, families and communiies who receive nursing care. Health prioriies for ICNP® terminology subsets it into at least one of three areas: health condi
-ions (e.g. mental health, HIV/AIDS, tuberculosis, chronic diseases, depression, lu, etc.); health specialiesor care
seings (e.g. midwifery, community nursing, family
nur-sing, cancer care, geriatric nurnur-sing, trauma and orthopedic nursing, palliaive care, etc.) and nursing phenomena (e.g. pain, faigue, self-care, urinary inconinence, treatment compliance, etc.)(7).
Moreover, a collecion of terms and concepts relevant to the health priority should be performed. The extracion process of terms can be done from medical records, oicial documents, research instruments, or any other sources that enable the obtainment of terms relevant to the cli-nical nursing pracice. The process of concept extracion, understood here as nursing diagnoses, outcomes and in-tervenions, should be done within the ICNP®, preferably in its latest version.
the International Classiication for nursing Practice
(ICnP®) is an important
technological resource that brings together
nursing diagnostic terms and concepts,
These steps require more careful atenion and efecive care by those who perform them, the adopion of a guide-line being necessary to enable the standardizaion of the strategies used in the extracion of terms and concepts by all professionals involved in this process, in order to prevent loss of relevant data(1). It requires accuracy and professional experience, consising of one of the main phases of the construcion of terminology subset, through which the data needed to perform the subsequent steps are obtained.
Once this step is inished, the extracted terms should be transcribed in terminology records, documents that support the collecion, registry and subsequent analysis of terms used in clinical nursing pracice and relevant to the priority chosen to structure the terminology subset. Ater exclusion of repeiions, the terms ideniied should be sub-mited to graphic correcion, standardizaion and content validaion. Likewise, the concepts should be transcribed and then analyzed to prove their use and relevance in clinical pracice aimed at the priority of the terminology subset. Maintenance & Operaions
This aspect involves cross mapping of terms and con-cepts extracted from the ICNP® terminology, and modeling of new concepts.
Cross mapping is a method used to compare terms of diferent classiicaion systems in order to determine their semanic equivalence. It can be used in the analysis of data of the nursing process, in diferent areas of clinical pracice, enabling the analysis of terms not included in standardized nursing languages in order to compare them with those in classiicaion systems and thus idenify the similarity of these terms, enabling its adaptaion to a standardized language(8-9).
In order to perform the cross mapping, the terms iden-iied in the data sources selected should be included in a spreadsheet, with the aid of computer sotware, as well as the terms of the ICNP®. These two spreadsheets are crossed in order to idenify the terms listed and not listed in this terminology – i.e., the terms that are already present in the ICNP® and those which are not, and to consitute a database of terms of clinical nursing pracice for the priority pre-viously selected, excluding terms belonging to other areas. For the development of these steps and subset con-solidaion, the collaboraion of expert nurses in the ield of the ICNP®nursing terminology is important, in order to validate the allocaion of terminology content according to the Seven-Axis Model(1). The deiniions of the seven axes are: focus – area of atenion that is relevant to nursing;
judgment -: clinical opinion or determinaion related to
the focus of nursing pracice; client - subject to which a diagnosis refers and who is the recpient of an intervenion;
acion – an intenional process applied to a client; means – a
manner or method of accomplishing a nursing intervenion;
locaion - anatomical and spaial orientaion of a diagnosis
or intervenion; ime - point, period, instance, interval or duraion of an occurrence(3).
From the bank of validated and normalized terms, nursing diagnoses, outcomes and intervenion statements should be developed based on the ICNP®Seven-Axis Model. As recommended by the ICN(3), based on ISO 18.104:2003 of the Internaional Organizaion for Standardizaion (Inter-naional Organizaion for Standardizaion - ISO)(10), in order to construct a nursing diagnosis and nursing outcome, the following guidelines should be used: a term of the focus
and judgment axes must be included; include addiional
terms from the focus and judgment axes and the other axes as needed.
The expected result is the measure or condiion of a diagnosis in a ime interval ater a nursing intervenion(11).
For the construcion of nursing intervenion statements, a term from the acion axis and a target term must be in-cluded, i.e. a term from any of the other axes, except the
judgment axis. Addiional terms from the other axes may
be included as needed(3,10).
The nursing diagnosis, outcome and intervenion sta-tements constructed add to the concepts ideniied in the ICNP®. Next, another cross mapping of these concepts with those contained in the ICNP®must be done in order to ideni-fy concepts listed and new concepts. The new concepts must be submited to the modeling process. For such purpose, it is recommended to check whether they are consistent with the modeling guidelines for the ICNP®nursing diagnoses, outcomes and intervenions, having as a parameter ISO 18104: Integraion of a reference terminology model for Nursing, which has been adopted by the ICN as basis for the construcion of the content of terminology subsets(6).
Once this process is inished, the nursing diagnosis, outcome and intervenion statements should be subjected to content validaion by experts in order to conirm their relevance to the clinical nursing pracice related to the priority selected to construct the ICNP®subset. Therefore, the relevance, evidenced priority, clinical applicability to the context and the people to whom care is aimed, familiarity of the professional with the use of the nursing process and the use of the terminology presented, among other relevant aspects, should be assessed in this phase.
Disseminaion & Educaion
This component covers the last two phases of the pro-cess of construcion of the ICNP®terminology subsets: the inalizaion and disseminaion of the catalogue. The irst step involves the structuring of the terminology subset, which must contain the signiicance for nursing, the the-oreical model and the list of nursing diagnosis, outcome and intervenion statements validated.
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for the conceptual and theoreical models that will guide its organizaion being determined by the researcher who develops them(7), depending on his/her pracice and the context in which it should work.
Ater the process of preparaion and organizaion of nursing diagnosis, outcome and intervenion statements, the next step is the modeling of concepts using Protégé
sotware, when an electronic ile of each terminology subset is generated in order to reduce errors in the ideniicaion of concepts and in the respecive codes (unique ideniiers). This step is performed in collaboraion with the ICN, resul-ing in a printed brochure for the subset, includresul-ing general informaion, code set and examples of how to use it in clinical pracice(6). Then a wide disseminaion of the subset is done globally in order to enable its validaion, aiming to verify its applicability and the use of a uniied language in diferent contexts of clinical nursing pracice worldwide.
CONTRIBUTIONS OF THE ICNP® SUBSETS
FOR CLINICAL NURSING PRACTICE
The construcion of the ICNP® terminology subsets ills a need to subsidize health informaion systems, by enabling the development of nursing diagnosis, outcome and inter-venion statements suitable to speciic areas of professional pracice. These subsets allow nurses to more easily integrate the ICNP® in diferent contexts of their daily pracice, being an easily accessible reference for these professionals in their areas. However, the subsets do not replace clinical reasoning and decision-making of the nurse, mandatory ele-ments for the provision of individualized care ater paient assessment(7). Its applicability, as well as its structure based on care systemaizaion, depends on the involvement of the professional in nursing pracice, supporing the resoluion of people’s and/or community’s problems(2).
The ICN(3) encourages the joint paricipaion of nurses, organizaions and centers for educaion and research in the nursing area in the development and tesing for validaion of the ICNP®subsets, as well as its disseminaion worldwide.
The paricipaion of the ICNP® Research and Deve-lopment Centers in the process of proposal submission, assessment criteria, scope of work and responsibiliies in the consolidaion of this classiicaion system and its disse-minaion worldwide is noteworthy.
The ICN and partners developed and disseminated ive ICNP® terminology subsets for diferent health priori-ies: treatment compliance(12), palliaive care for digniied death(13), indicators of nursing outcomes(14), community nursing(15), and, treatment of pediatric pain(16). The deve-lopment of these subsets has contributed greatly to the universalizaion of a standardized language to be used by nurses worldwide as a technological resource to strengthen and expand the purposes of the profession regarding the atenion given to the human being in the health-disease process, considering the human life cycle.
In Brazil, the ICNP® Research and Development Center at the Nursing Postgraduate Program, Federal University of Paraíba, approved by the ICN in 2007, develops the use of ICNP® in the professional pracice regarding nursing educaion, research and care, contribuing to the construcion, coninuous development and consolidaion of a reference terminology(17).
Since its creaion, four proposals of ICNP®subsets have been constructed: for paients with congesive heart failu-re(18), for cancer pain(19), for hypertension in primary care(20), and for elderly in the city of João Pessoa(21). These proposals are in the process of clinical validaion for subsequent sub-mission for approval by the ICN.
Currently, this Center is developing two ICNP® termi-nology subsets: one for hospitalized diabeic paients and another for paients ater prostatectomy. Furthermore, it collaborates with other insituions in several Brazilian states where proposals of ICNP® terminology subsets have also been developed related to diferent contexts of clinical nursing pracice, namely: indigenous health nursing, reha-bilitaion care, neonatology, obstetrics and systemaizaion of nursing pracice in primary care(22).
The worldwide disseminaion of these subsets allows the adopion of a standardized and speciic language to diagno-se, intervene and evaluate the outcome of care provided to individuals, families and communiies within clinical nursing pracice. The use of the ICNP®subsets allows the universaliza-ion of the nursing professuniversaliza-ionals’ language in order to idenify, explain and assess the elements that describe clinical prac-ice, enabling the improvement of nursing acions through more relecive, efecive and eicient care; facilitaing the communicaion and relaional process among nurses and other members of the mulidisciplinary health care team and providing the profession with greater recogniion and visibility in the diferent contexts of the everyday pracice.
CONCLUSION
The development of the ICNP® terminology subsets is a technological strategy relevant to the systemaizaion of nursing care, since it takes into account the main elements of its pracice (nursing diagnoses, outcomes and intervenions), through the use of a uniied vocabulary, suitable to a worldwi-de language, consiworldwi-dering cultural, social and local inluences, and professional peculiariies in the use of technical terms. Given the concern in disseminaing such care possibiliies, the construcion of knowledge about the the ICNP® terminology subsets is leveraged, highlighing the most relevant aspects for structuring and use in clinical nursing pracice.
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